Provider Demographics
NPI:1306900626
Name:PUTTASWAMY, RAJEEV (SLP)
Entity type:Individual
Prefix:
First Name:RAJEEV
Middle Name:
Last Name:PUTTASWAMY
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-1802
Mailing Address - Country:US
Mailing Address - Phone:914-629-3680
Mailing Address - Fax:
Practice Address - Street 1:50 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-1802
Practice Address - Country:US
Practice Address - Phone:914-629-3680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011313235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY011313OtherLICENSE #